CERTIFICATE OF LIABILITY INSURANCE
r.
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE IMM/DDIYYI
10108/02
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
ACaRDIA EAST - TAMPA BAY
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
GULF INSURANCE COMPANY
FIREMAN'S FUND INSURANCE CO
Zenith Insurance Co-DB
PACT, Inc., Performing Arts
Center Foundation, Inc.
1111 McMullen Booth Road
Clearwater FL 33759
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR
A ~NERAL LIABILITY CGL7761996 10101/02 10101/03 EACH OCCURRENCE $ 1000000
e-X 3MMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100000
CLAIMS MADi: [lS] OCCUR MED EXP (Anyone person) $
f--
PERSONAL & ADV INJURY $ 1000000
r--
GENERAL AGGREGATE $ 2000000
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
!Xl POLICY n ~~R;. n LOC
A AUTOMOBILE LIABILITY BA0612555 10101/02 10101103 COMBINED SINGLE LIMIT
f-- $ 1000000
ANY AUTO (Ea accident)
r--
ALL OWNED AUTOS BODILY INJURY
f-- $
e-X SCHEDULED AUTOS (Per person)
r1S- HIRED AUTOS BODILY INJURY
$
r1S- NON-OWNED AUTOS (Per accident)
r-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS LIABILITY XYZ75770602 10101/02 10101/03 EACH OCCURRENCE $ 10000000
Q OCCUR D CLAIMS MADE AGGREGATE $ 10000000
$
R DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND Z836094209 1/01/02 1/01/03 I WC STATU., I 10TH.
X TORY LIMITS ER
EMPLOYERS' LIABILITY
., - ~. -- --------- u __ __ -, E.L. EACH ACCIDENT , $ ~OOOOOO .,
E.L. DISEASE - EA EM PLOYEE $ 1000000
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
.'-, ~- .... r- ,., , --- -
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS r"nL';'\"'/C.ll, L:..L)
CITY IS ADDITIONAL INSURED AS OWNER/LESSOR OF PREMISES
OC1 1 iJ ;wuz
* 1 0 DAYS NOTICE OF CANCELLATION APPLIES FOR NON PAYMENT EXCEPT FOR RISK iv1I\NAGEMENT
WORKERS COMPENSATION.
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~
DAYS WRITTEN
ATTN: LEO SCHRADER, RISK MGMT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
POBOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CLEARWATER FL 33758-4748 REPRESEIVATIVES. )
AUTH A~1:J1l A
c.-..-'''' ..- "'VI'''' --
I
ACORD 25-S (7/97) R-l S K. 45- 50 @ACORD CORPORATION 1988
C \,-t\ <: LetL K.
~c.: {JPrfLK.5
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-8 (7/97)